Chronic depression (II)

This will be my last post about the book. Below I have added some more observations from some of the remaining chapters of the book – I noticed after I’d published this post that a few similar observations were also included in the first post, but in the end I decided against removing those arguably superfluous observations from this post (‘if the authors are allowed to repeat themselves, so am I…’).

…

“General avoidance often weaves its way through the fabric of depressed persons’ lives. One of my (Pettit’s) first clinical supervisors proposed that avoidance captures the true essence of depression. He argued that depression, at its root, is simply the opposite of participation. Although this is surely an overly broad and simplistic conceptualization of depression, it highlights the idea that depressed people are often passive recipients of life, rather than active participants in life. […] depressed persons often have less developed social networks […] depressed persons often exhibit generalized problems with social avoidance. What’s more, evidence suggests that depression is frequently preceded by anxiety of some form […]. Anxiety, of course, is characterized by avoidance of some feared object, cognition, or event. Although anxiety and general social avoidance certainly play a role in depression, a more specific form of social avoidance appears more pertinent to the propagation of depression: Avoidance of interpersonal conflict. We argue that depression is characterized, and even propagated, by a pattern of interpersonal conflict avoidance.”

“It is well-known that depression is associated with a number of factors related to interpersonal avoidance. Four such factors (i.e., low assertiveness, social withdrawal, general avoidance, and shyness) have specifically been identified as interpersonal characteristics of a large number of depressed individuals. […] Two characteristics of assertive behaviors may be of great difficulty to depressed persons. First, asserting oneself requires active engagement with others, which forces the depressed person to overcome feelings of general social anxiety, in addition to overcoming the lethargy and indifference that retard activity in general among such individuals. Second, and more important, assertive behaviors entail making explicit requests of others. Social conventions dictate that requests naturally merit a response, be it positive or negative, and it is at this point that the interpersonal stage for potential disharmony is set. To reach this point, one must conquer general social anxiety and place himself or herself in a position that allows for the possibility of negative, rejecting responses from others. This latter possibility appears to be the sticking point for many depressed persons. That is, depressed persons overcome social inhibition and inertia but are often unwilling to knowingly make themselves vulnerable to interpersonal rejection (although they often engage in behaviors that unknowingly place themselves at greater risk of rejection, such as excessive reassurance-seeking). […] assertiveness is often quite difficult for depressed people. Assertiveness is a necessary component of successful conflict negotiation. […] Avoiding assertive behaviors […] allows the individual to escape the discomfort of receiving negative reactions from others. It also, however, lessens the individual’s chances of obtaining desired outcomes”.

“Price, Sloman, Gardner, Gilbert, and Rohde (1994) argued that depression-related states and behaviors represent evolved forms of a primordial “involuntary subordinate strategy.” Price et al. contended that the involuntary subordinate strategy arose primarily as a means to cope with social competition and conflict, particularly losses therein. Out of this framework, the primary function of depression is to resolve interpersonal conflicts by presenting a “no threat” signal to others. Recent animal research has provided a degree of support for this proposition. In work with cynomolgus monkeys, Shively, Laber-Laird, and Anton (1997) manipulated the social status of a group of females, such that previously dominant monkeys became subordinate to formerly subordinate monkeys. This reduction in social status produced behavioral and hormonal reactions corresponding to depressive reactions among humans. Behaviorally, these monkeys exhibited fearful scanning of the environment, and more important, decreased social affiliation. These behavioral changes suggest that the newly subordinate monkeys were engaging in interpersonal avoidance. Similarly, the monkeys’ hormonal activity transformed, and they began hypersecreting cortisol. Research has demonstrated that hypersecretion of cortisol occurs more frequently among depressed humans […]. Other studies of animal social hierarchies and avoidance provide results consistent with those of Shively et al.”

“It is interesting to note that [a] pattern of being overly reserved or acquiescing with strangers, but extremely negative and antagonistic toward close relatives or romantic partners, is quite common among people who are depressed.”

“[R]esearch on a phenomenon called self-handicapping indicates that depressed people may gain self-protective and other rewards for depressive cognition and behavior. These rewards serve to maintain depressive cognition and behavior, and thereby perpetuate depression. Self-handicapping, a concept with origins in the field of social psychology, refers to placing obstacles in the way of one’s performance on tasks so as to furnish oneself with an external attribution when future outcomes are uncertain […]. That is, in the anticipation of a possible failure or a poor performance of some sort, people may either claim to have some limitation or actuallyproduce a limitation that provides an explanation in the event that they perform poorly. Self-handicapping is a frequently occurring phenomenon and is not limited to depressed people. […] A series of studies by Baumgardner (1991) found self-handicapping, in general, appears to occur in one of two situations. First, it may occur when people have experienced a failure privately and hold concerns about that failure becoming public. […] People may also self-handicap when they have experienced a success publicly yet doubt their ability to maintain that success.”

“[T]wo forms of self-handicapping exist: claimed and acquired (these have also been referred to as self-reported and behavioral, respectively). Claimed handicaps are likely more common than acquired handicaps. […] claimed handicaps occur when people believe that the handicap will explain their poor performance. Acquired handicaps, however, occur when people (a) believe the handicap will explain their poor performance and (b) believe that the handicap will lower others’ future expectations. Both forms of self-handicapping are likely relevant to depression […] evidence suggests that self-handicapping, at least behavioral self-handicapping, occurs more frequently among men than women […]. Self-reported, or claimed, handicaps occur at similar rates among men and women. […] empirical evidence confirms that depressed people are more likely to self-handicap than others.”

“[S]elf-handicapping operates on both intrapsychic and interpersonal levels. That is, the handicap provides the individual a cognitive explanation of the failed performance and also provides an explanation to others who may be privy to the failure. […] In addition to providing an external attribution for failure, barriers to performance increase the likelihood of internal credit for success (i.e., self-enhancement). Consequently, individuals who self-handicap apparently benefit regardless of whether they succeed or fail. […] people self-handicap in the social arena with the goal of promoting a more positive image. Ironically, self-handicapping tends to have the reverse effect [“the perception that people [are] making excuses for their performance” can be damaging, regardless of actual performance] […] lower social expectations presage lower social opportunities, which by itself is a bad prognostic sign for depression. […] Although further empirical research on the interpersonal sequelae of these behaviors is needed before firm conclusions are drawn, they likely reduce opportunities for positive social engagement, increase antagonistic behaviors from others, and reconfirm depressed persons’ views that they are socially inept. The end result, tragically, is continued and exacerbated depression. […] When taken to an extreme, chronic behavioral self-handicapping may significantly hinder interpersonal relations and lead to the development of maladaptive behaviors such as alcoholism and substance dependence.”

“Sacco [argued in a publication] that depressed people’s relationship partners develop mental representations of them that become relatively autonomous and that bias subsequent perceptions of their depressed partners. […] students [in the study] were more likely to attribute the depressed person’s failures to internal, controllable causes, whereas the nondepressed person’s failures were judged to result more from external, uncontrollable factors. Students also considered the causes for failures to be more stable and have a wider impact on the depressed person’s life, as compared with the nondepressed person. The reverse pattern was seen for successful events. That is, successes were judged to result from external, uncontrollable factors among the depressed person but internal, controllable factors for the nondepressed person. Both of these processes are important — depressed persons not only are blamed more for negative events but also are given less credit when positive events occur […] [That] [f]ailures [are] attributed to enduring traits of depressed persons [by others] [and are] viewed as under the control of depressed persons (i.e., the depressed person could have avoided the failure if they had really tried) […] is strikingly similar to depressed persons’ characteristic self-blaming attitude. They attribute their own failures to internal, stable, and global factors […] [In short,] most depressed persons’, attributions are clearly saturated with self-directed blame [and] others tend to adopt the same negative, blaming attributions and behaviors toward depressed persons. […] Once formed, the mental representations [of others] remain stable, regardless of whether the depression has remitted. […] representations of negative behaviors, once solidified, are more difficult to alter than representations of positive behaviors”.

“Others not only fail to recognize positive attributes but also alter their interaction styles with the depressed person. There is evidence that others’ negative views subserve the communications they emit to the negatively represented person. For example, the literature on attributions and relationship functioning has documented a connection between negative attributions and blaming communications […] In short, negative attributions lead to blaming communications and decreased relationship satisfaction. […] Blaming communications, in turn, represent a specific instance of the array of interpersonal indicators shown to predict depression chronicity. […] blame maintenance essentially assures that others will continue to hold negative views of depressed persons, regardless of the depressed persons’ presentations. […] In the context of specifically targeting blame maintenance (or any of the other processes), simultaneous attention to the other processes is warranted, lest resolution of one exacerbate another […]. As an example, blame may serve as a source of selfverification for depressed people. If blame is reduced, negative self-verification strivings may be thwarted, which, in turn, may lead to attempts to restore blame or to meet self-verification needs in other ways (e.g., by reducing performance in a previously adaptive domain) or in other relationships (e.g., with friends).”

“The tendency to avoid potentially uncomfortable social interactions is a stable trait, with shyness demonstrating remarkable consistency from early childhood until late adulthood. […] Shyness has been implicated as a risk factor for depression. […] Social skills represent another potential stable vulnerability to depression. […] people who display poor social skills are less likely to obtain positive outcomes and avoid negative outcomes in interpersonal relationships. As a result, they are more likely to become and stay depressed […] an impressive amount of evidence suggests that people who are depressed also display poor social skills. […] When maladaptive interpersonal behaviors compromise relationships, shy people are more likely to experience loneliness [and] less likely to have good social support […], and are therefore more likely to become even more depressed.”

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Goodreads Quotes

"Happiness and its anticipation are […] proximate mechanisms that lead us to perform and repeat acts that in the environments of history, at least, would have led to greater reproductive success." (Richard D. Alexander)